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2.
J Surg Res ; 245: 569-576, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31494390

RESUMO

BACKGROUND: Enhanced recovery after surgery (ERAS) following pancreaticoduodenectomy (PD) is popular and safe. This study aimed to describe the incidence, causative factors, and clinical impact of deviation from and failure of an ERAS protocol. MATERIALS AND METHODS: A prospective cohort analysis of elective PD patients managed according to an ERAS protocol between October 2015 and June 2018 was performed. Univariate and multivariate analyses identified variables associated with protocol deviation and failure. The relationship between protocol deviation and failure was also explored. RESULTS: A total of 97 patients were identified comprising of 46 females and 51 males. The median age was 68 y (range 17-85). Twenty-one patients (21.6%) suffered serious complications, whereas two (2.1%) died perioperatively. The median length of stay (LoS) was 14 d (6-36). In total, 73 (75.3%) patients deviated, whereas 39 (40.2%) failed the protocol. On univariate analysis, protocol deviation was associated with male gender, surgery time ≥270 min, and prolonged LoS. On multivariate analysis only prolonged LoS remained significant. Only serious complications were associated with protocol failure on multivariate analysis. Protocol deviation was not associated with significant complications nor ERAS protocol failure. CONCLUSIONS: ERAS protocol deviation does not alter the course of those destined to protocol failure. Greater understanding into the causative factors of either protocol deviation or failure may be the only way to personalize care and realize the maximal benefit of ERAS in this specific group of patients.


Assuntos
Procedimentos Cirúrgicos Eletivos/efeitos adversos , Pancreaticoduodenectomia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Israel/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Estudos Prospectivos , Falha de Tratamento , Adulto Jovem
3.
J Surg Res ; 245: 81-88, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31404894

RESUMO

BACKGROUND: Delayed emergency department (ED) LOS has been associated with increased mortality and increased hospital length of stay (LOS) for various patient populations. Trauma patients often require significant effort in evaluation, workup, and disposition; however, patient and hospital characteristics associated with increased LOS in the ED for trauma patients remain unclear. METHODS: The Trauma Quality Improvement Project database (2014-2016) was queried for all adult blunt trauma patients. Patients discharged from the ED to the operating room were excluded. Univariate and multivariable linear regression analysis was conducted to identify independent predictors of ED LOS, controlling for patient characteristics (age, gender, race, insurance status), hospital characteristics (teaching status, ACS trauma verification level, geographic region), abbreviated injury scale and comorbid status. RESULTS: 412,000 patients met inclusion criteria for analysis. When controlling for covariates, an increase in age by 1 y resulted in 0.63 increased minutes in the ED (P < 0.001). In multivariable linear regression controlling for injury severity and comorbid conditions, non-white race groups, university status, and northeast region were associated with increased ED LOS. Black and Hispanic patients spent on average 41 and 42 more minutes, respectively, in the ED room when compared with white patients (P < 0.001). Patients seen at University hospitals spent 52 more minutes in the ED when compared with community hospitals, whereas patients at nonteaching hospitals spent 31 fewer minutes (P < 0.001). Patients seen in the Midwest spent the least amount of time in the ED, with patients in the South, West, and Northeast spending 45, 36, and 89 more minutes, respectively (P < 0.001). Non-Medicaid patients at level 1 trauma centers and those requiring intensive care admission had significantly decreased ED LOS. Medicaid patients took the longest to move through the ED with Medicare, BlueCross, and Private insurance outpacing them by 17, 23, and 23 min, respectively (P < 0.001). ACS level 1 trauma centers moved patients through the ED fastest, whereas ACS level II trauma centers and level III trauma centers moved patients through 50 and 130 min slower when compared with ACS level 1 trauma centers (P < 0.001). CONCLUSIONS: ED LOS varied significantly by patient and hospital characteristics. Medicaid patients and those patients at university hospitals were associated with significantly higher ED LOS, whereas ACS trauma verification level status had strong correlation with ED LOS. These results may allow targeted quality improvement programs to enhance ED LOS.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Ferimentos não Penetrantes/terapia , Escala Resumida de Ferimentos , Adolescente , Adulto , Idoso , Feminino , Hospitais Comunitários/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Medição de Risco/métodos , Análise de Sobrevida , Estados Unidos , Ferimentos não Penetrantes/diagnóstico , Ferimentos não Penetrantes/mortalidade , Adulto Jovem
4.
Virchows Arch ; 475(6): 781-788, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31691009

RESUMO

The use of clinical autopsy has been in decline for many years throughout healthcare systems of developed countries despite studies showing substantial discrepancies between autopsy results and pre-mortal clinical diagnoses. We conducted a study to evaluate over time the use and results of clinical autopsies in Sweden. We reviewed the autopsy reports and autopsy referrals of 2410 adult (age > 17) deceased patients referred to two University hospitals in Sweden during two plus two years, a decade apart. There was a decline in the number of autopsies performed over time, however, mainly in one of the two hospitals. The proportion of autopsy referrals from the emergency department increased from 9 to 16%, while the proportion of referrals from regular hospital wards was almost halved. The autopsies revealed a high prevalence of cardiovascular disease, with myocardial infarction and cerebrovascular lesion found in 40% and 19% of all cases, respectively. In a large proportion of cases (> 30%), significant findings of disease were not anticipated before autopsy, as judged from the referral document and additional data obtained in some but not all cases. In accordance with previous research, our study confirms a declining rate of autopsy even at tertiary, academic hospitals and points out factors possibly involved in the decline.


Assuntos
Autopsia , Causas de Morte , Erros de Diagnóstico/estatística & dados numéricos , Infarto do Miocárdio/mortalidade , Autopsia/métodos , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Infarto do Miocárdio/diagnóstico , Prevalência , Estudos Retrospectivos , Suécia
5.
Biochem Med (Zagreb) ; 29(3): 030705, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31624458

RESUMO

Introduction: Inappropriate laboratory retesting can be addressed by implementing minimum retesting intervals (MRI). The aim of our study was to assess the effectiveness of the implemented MRI protocol for inpatients. Materials and methods: Minimum retesting intervals were applied for 53 laboratory tests. The overall reduction of test requests, reduction in charges and reagent cost savings, frequency of MRI alert appearance as well as the rate of MRI acceptance and ignorance were calculated for a one-year period. Reasons for violating the MRI rule, hospital departments that contributed mostly to MRI rule violation, and the frequency of MRI violations between routine and emergency laboratory were evaluated. Results: During the one-year period, 106,780 requests violated the MRI rule, which corresponds to 14.8% of all requests received. 13,843 requests were cancelled, yielding a 1.9% reduction of requested tests. High-volume tests, namely complete blood count, C-reactive protein, alanine aminotransferase, gamma-glutamyltransferase and total bilirubin, accounted for 65% of all generated alerts and had the highest alert ignorance (>85%). The highest cancellation rate was observed for tumor markers and autoimmunity tests, for most being at least 50%. Annual charge reduction was 62,641 EUR while reagent cost savings were 11,408 EUR. Tests performed in the emergency laboratory had a higher alert appearance than the same routine tests. The most common reason for MRI violation was clinical justification based on the patient's condition. Most frequently ignored MRI alerts were in the intensive care unit. Conclusion: MRI implementation showed limited effectiveness in reducing testing repetition and achieving financial savings, yet provided the basis for future improvements.


Assuntos
Serviços de Laboratório Clínico , Croácia , Hospitais Universitários/estatística & dados numéricos , Humanos , Laboratórios
6.
Artigo em Inglês | MEDLINE | ID: mdl-31505726

RESUMO

Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Tempo de Internação , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha
7.
J Laparoendosc Adv Surg Tech A ; 29(10): 1357-1361, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31539304

RESUMO

Introduction: In pediatric population, the two most common indications for splenectomy include traumatic rupture and hematological diseases such as hereditary spherocytosis, idiopathic thrombocytopenic purpura, sickle cell disease, and autoimmune hemolytic anemia. Traditionally, splenectomy has been an open procedure; however, since the first laparoscopic splenectomy was reported in 1991, the minimally invasive laparoscopic approach has become increasingly popular. In most public hospitals in Brazil, where vessel sealing devices are not available, most surgeons seem to prefer open splenectomy to guarantee intraoperative safety and improved outcomes. Objectives: To compare outcomes between open and laparoscopic splenectomy in children in a public hospital in Brazil. Materials and Methods: Retrospective study conducted between January 2010 and June 2018. Patients from 0 to 14 years old who underwent open or laparoscopic splenectomy at the University Hospital of Federal University of Paraná were included. Clinical, laboratory, imaging, and surgical data were collected. Results: For 8 years, 35 patients underwent splenectomy. Mean age was 4 years old and 54% were female. Of the 35 subjects, 69% had sickle cell anemia and 23% spherocytosis. The most common indication for surgery was a previous episode of splenic sequestration. The 13 laparoscopic surgeries were performed without harmonic scalpel or other vessel sealing devices. During the laparoscopic procedure, 2 patients experienced intraoperative complications: bleeding and prolonged surgical time due to technical problems with the equipment. Mean operative time was higher in laparoscopy group than in open group (186 minutes versus 66 minutes). Oral feeds began earlier on the laparoscopic group. Postoperatively, there were more complications on the open group, and no reoperations. There was only one fatality, likely secondary to fulminant sepsis, which occurred 34 days after the surgery in a patient who was undergoing prophylactic oral antibiotics therapy. Discussion: Performing laparoscopic splenectomy without harmonic scalpel or other vessel sealing devices is feasible, but it implicates in a significantly higher surgical time. Laparoscopic splenectomy had earlier oral feeds and fewer complications than open surgery.


Assuntos
Laparoscopia , Esplenectomia/métodos , Adolescente , Brasil , Criança , Pré-Escolar , Feminino , Doenças Hematológicas/cirurgia , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Laparoscopia/métodos , Masculino , Duração da Cirurgia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Baço/lesões , Ferimentos e Lesões/cirurgia
8.
Am J Health Syst Pharm ; 76(Supplement_3): S74-S78, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31418772

RESUMO

PURPOSE: The development and implementation of centralized mail-order pharmacy services in an academic healthcare system are described. SUMMARY: The use of mail-order pharmacy services continues to increase, as mail-order services offer patient benefits such as reduced copayments and improved clinical outcomes. Prior to undertaking an initiative to improve its mail-order pharmacy services, the University of Utah Health system's pharmacy department offered decentralized mail-order pharmacy services at all of its retail pharmacies, but there was no standardized process for processing mail-order prescriptions or providing phone support to mail-order patients. Centralized mail-order pharmacy services were developed and implemented by creating (1) a standard process for mail-order pharmacy services, (2) a centralized mail-order prescription filling center, and (3) a call center to support mail-order pharmacy services. Implementation of centralized mail-order pharmacy services resulted in an almost 50% reduction in time spent by pharmacy team members on mail-order prescription filling and packaging tasks. Use of a central call center resulted in a decreased call abandonment rate and contributed to a decreased pharmacy workload resulting from an overall reduction in call volume due to an increased rate of first-call issue resolution. CONCLUSION: Establishment of a centralized mail-order pharmacy service along with operational and infrastructure improvements resulted in improved quality and regulatory compliance and enhanced labor efficiency and patient communication.


Assuntos
Implementação de Plano de Saúde , Farmácias/organização & administração , Serviço de Farmácia Hospitalar/organização & administração , Serviços Postais , Call Centers/organização & administração , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Farmácias/estatística & dados numéricos , Farmacêuticos/organização & administração , Farmacêuticos/estatística & dados numéricos , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde , Carga de Trabalho/estatística & dados numéricos
9.
Medicine (Baltimore) ; 98(34): e16951, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31441892

RESUMO

Teaching status/academic ranking may play a role in the variations in trauma center (TC) outcomes. Our study aimed to determine the relationship between TC teaching status and injury-adjusted, all-cause mortality in a national sampling.Retrospective review of the National Sample Program (NSP) from the National Trauma Data bank (NTDB). TCs were categorized based on teaching status. Adjusted mortality was determined by observed/expected (O/E) mortality ratios, derived using TRauma Injury Severity Score methodology from the Injury Severity Score and Revised Trauma Score. Chi-square and t test analyses were utilized with a statistical significance defined as P <.05.Of the 94 TCs in the NSP, 46 were university, 38 were community teaching, and 10 were community nonteaching. For the University TCs, 62.8% were American College of Surgeons (ACS) level 1 and 81.2% state level 1. Of the community teaching TCs, 39.0% was ACS level 1 and 35.1% was state level 1. Of the community nonteaching TCs, 0% was ACS level 1 and 11.1% was state level 1. University TCs had a significantly higher O/E mortality rate than community teaching (0.75 vs 0.71; P = .04). There were no differences in O/E between community teaching and nonteaching TCs (0.71 vs 0.70; P = .70).Community teaching and nonteaching TCs have lower injury-adjusted, all-cause mortality rates than University Centers. Future studies should further investigate key differences between University TCs and community teaching TC to evaluate possible quality and performance improvement measures.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Centros de Traumatologia/normas , Ferimentos e Lesões/mortalidade , Adulto , Bases de Dados Factuais , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Estudos Retrospectivos , Centros de Traumatologia/classificação , Estados Unidos
10.
Braz J Infect Dis ; 23(4): 231-236, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31351815

RESUMO

INTRODUCTION: Vaccination with tetanus-diphtheria-acellular pertussis (Tdap) has been recommended for healthcare workers (HCWs) by Brazilian Ministry of Health since November 2014. OBJECTIVE: To describe the strategies implemented to improve Tdap uptake, cumulative vaccine coverage after each intervention, variables associated to Tdap vaccination, and reasons for non-vaccination among HCWs of the main building of a quaternary hospital attached to the Sao Paulo University Medical School. METHODS: A list of HCWs eligible for pertussis vaccination was generated. From April to December 2015, the following interventions were implemented: note on intern journal reminding the importance of pertussis vaccination; email to the head nurses strengthening vaccine recommendations; lectures on pertussis and Tdap for physicians of Obstetrics and Neonatology Clinics; on-site vaccination by mobile teams at the Obstetrics, Neonatology, and Anesthesiology Clinics. Vaccine coverage was accessed at the end of each month. Multivariate Poisson regression model with a robust error variance was used to evaluate variables associated with Tdap vaccination. Reasons for non-vaccination were evaluated from January to May 2017 through phone calls for HCWs who had not received Tdap. RESULTS: The study included 456 HCWs. After the interventions, Tdap coverage raised from 2.8% to 41.2%. In the multivariate analysis, occupation (physician), working place (obstetrics or anesthesiology) and influenza vaccination in 2015 were independently associated to Tdap vaccination. The main reason for non-vaccination was unawareness of Tdap recommendations. CONCLUSIONS: Tdap uptake among HCWs was low in our hospital. Providing vaccination at convenient places/times for HCW seems to be the most efficient strategy to increase vaccine uptake.


Assuntos
Vacinas contra Difteria, Tétano e Coqueluche Acelular , Pessoal de Saúde/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Cobertura Vacinal/métodos , Cobertura Vacinal/estatística & dados numéricos , Adulto , Brasil , Feminino , Humanos , Programas de Imunização/métodos , Masculino , Análise Multivariada , Distribuição de Poisson , Vigilância da População , Fatores de Tempo , Local de Trabalho/estatística & dados numéricos
11.
Cancer Radiother ; 23(5): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331842

RESUMO

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.


Assuntos
Tomografia Computadorizada Quadridimensional , Planejamento da Radioterapia Assistida por Computador/métodos , Artefatos , Institutos de Câncer/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Imagem Tridimensional/estatística & dados numéricos , Movimento (Física) , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/tendências , Respiração
12.
Korean J Parasitol ; 57(3): 265-271, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31284349

RESUMO

The prevalence of human taeniasis has decreased in Korea. The stool egg positive proportion decreased from 1.9% in 1971 to 0% in 2004 in nationwide surveys. The neurocysticercosis (NCC) is also presumed to decrease. However, detailed information regarding the recent status of NCC in Korea is lacking. We retrospectively reviewed NCC cases from 1990 to 2016 at Asan Medical Center, a 2700-bed tertiary referral hospital in Korea. We identified patients based on clinical symptoms, brain imaging, pathology and serological assay. The cases were classified as parenchymal, extraparenchymal, and mixed NCC. Eighty-one patients were included in the analysis. The mean age was 54.5 years, and 79.0% were male. The number of NCC cases was highest from 1995 to 1999, and continuously decreased thereafter. Forty (49.4%) patients had parenchymal NCC, while 25 (30.9%) patients had extraparenchymal NCC, and 16 (19.8%) patients had mixed NCC. The seizure and headache were most common symptom of parenchymal NCC and extraparenchymal NCC respectively. Hydrocephalus was more common in extraparenchymal NCC, and patients with extraparenchymal NCC were more likely to require a ventriculoperitoneal shunt. Cases of NCC are decreasing accordingly with human taeniasis and lesion location was the most important determinant of clinical presentation and outcome of NCC in Korea.


Assuntos
Neurocisticercose/epidemiologia , Adulto , Idoso , Feminino , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Neurocisticercose/diagnóstico , Prevalência , República da Coreia , Estudos Retrospectivos , Adulto Jovem
13.
Rev Bras Enferm ; 72(3): 767-773, 2019 Jun 27.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31269144

RESUMO

OBJECTIVE: To evaluate nurse safety culture in a teaching hospital, as well as to verify differences in the safety culture dimensions between services. METHOD: cross-sectional, quantitative study, conducted from October to December 2015, in a university hospital. The instrument Hospital Survey on Patient Safety Culture was applied. RESULTS: A total of 195 nurses from four different services participated in the study. Significant difference between services were identified for five dimensions of safety culture: organizational learning (P=0.012); return of information and communication about error (P=0.014); management support for patient safety (P=0.001); general perceptions about patient safety (P=0.005); and frequency of event notification (P=0.003). CONCLUSION: The medical clinic service had the highest statistical difference between the dimensions. These evaluations allow managers to identify the differences between the same hospital's services, serving as a warning and assisting in the services' improvement.


Assuntos
Enfermeiras e Enfermeiros/psicologia , Serviços de Enfermagem/normas , Gestão da Segurança/normas , Adulto , Atitude do Pessoal de Saúde , Brasil , Estudos Transversais , Feminino , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Serviços de Enfermagem/estatística & dados numéricos , Cultura Organizacional , Gestão da Segurança/estatística & dados numéricos , Estatísticas não Paramétricas , Inquéritos e Questionários
14.
BMC Pregnancy Childbirth ; 19(1): 238, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288780

RESUMO

BACKGROUND: There are several international guidelines on oxytocin regimens for induction and augmentation of labour, but no agreement on a standardised regimen in Germany. This study collated and reviewed the oxytocin regimens used for labour augmentation in university hospitals, with the long-term aim of contributing to the development of a national clinical guideline. METHODS: Germany has 34 university hospital compounds, representing 39 maternity units. In this observational study we asked units to provide standard operational procedures on oxytocin augmentation during labour or provide the details in a structured survey. Data were collected on the dosage of oxytocin, type and volume of solutions used, indications and contraindications for use and discontinuation, case-specific administration, and on who developed the procedures. Findings were analysed descriptively. RESULTS: A total of 35 (90%) units participated in this study. Standard operating procedures were available in 24 units (69%), seven units (20%) did not have procedures and information was missing from four units (11%). Midwives participated in the development of standard operating procedures in 15 units (43%). Infusions were most commonly prepared using six units of oxytocin in 500 ml 0.9% normal saline solution (12 mU/ml). The infusions were started at 120 mU/hour and increased by 120 mU/hour at 20-min intervals up to a maximum dosage of 1200 mU/hour. The most common indication for use was delayed progress in labour. Infusions were stopped when uterine contractions became hypertonic and/or the fetal heart rate showed signs of distress. Most of the practices described aligned with international guidance. All units used reduced oxytocin dosages for women with a history of previous caesareans section, as recommended in the international guidelines, and restrictive use was advised in multiparous women. The main difference between units related to combined use of amniotomy and oxytocin, recommended by three guidelines but used in only four maternity units (11%). CONCLUSIONS: While there was considerable variation in the oxytocin augmentation procedures, most but not all practices used in these 35 German maternity units were comparable. Establishing a national guideline on the criteria for and administration of oxytocin for augmentation of labour would eliminate the observed differences and minimise risk of administration and medication error.


Assuntos
Hospitais Universitários/estatística & dados numéricos , Trabalho de Parto Induzido/estatística & dados numéricos , Ocitócicos/uso terapêutico , Ocitocina/uso terapêutico , Adulto , Feminino , Alemanha , Hospitais Universitários/normas , Humanos , Trabalho de Parto Induzido/métodos , Trabalho de Parto Induzido/normas , Ocitócicos/normas , Ocitocina/normas , Guias de Prática Clínica como Assunto , Gravidez , Inquéritos e Questionários
15.
Tidsskr Nor Laegeforen ; 139(10)2019 06 25.
Artigo em Norueguês | MEDLINE | ID: mdl-31238674

RESUMO

BACKGROUND: Bariatric surgery has been performed at Oslo University Hospital since 2004. We wished to describe patient characteristics, use of surgical methods and perioperative complications in the period 2004-14. MATERIAL AND METHOD: We performed a retrospective analysis of prospective data collected for the period 2004-14. Complications include events during hospitalisation and up to 6-8 weeks postoperatively. RESULTS: Altogether 2 127 patients underwent surgery for morbid obesity, whereof 1 468 were women. Average age and body mass index were 42 years (range 17-73) and 46.2 kg/m2 (range 26-92). A total of 512 had a body mass index ≥ 50 kg/m2. Obesity-related sequelae were registered in 1 196 patients before surgery. Gastric bypass was performed in 1 966 patients, gastric sleeve resection in 122 (17 of these later underwent duodenal switch) and duodenal switch in 56 patients. All patients were operated laparoscopically, and four procedures were converted to laparotomy. Median hospitalisation time was two days (range 1-78). Complications were registered in 209 patients, 75 of whom had severe complications (grade ≥ IIIb on the Clavien-Dindo classification system). Patients with a body mass index ≥ 50 kg/m2 had a higher incidence of complications (12.5 % vs 8.9 %). Altogether 67 patients underwent further surgery. Six patients died, two of whom more than 30 days after the operation. The incidence of complications was reduced during the period. INTERPRETATION: Bariatric surgery may be performed laparoscopically with a low incidence of complications and short hospitalisation times. A large proportion of the patients who underwent surgery had obesity-related sequalae.


Assuntos
Cirurgia Bariátrica , Obesidade Mórbida/cirurgia , Adolescente , Adulto , Idoso , Cirurgia Bariátrica/efeitos adversos , Cirurgia Bariátrica/métodos , Cirurgia Bariátrica/estatística & dados numéricos , Índice de Massa Corporal , Feminino , Gastrectomia/estatística & dados numéricos , Derivação Gástrica/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Laparoscopia/estatística & dados numéricos , Laparotomia/estatística & dados numéricos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Noruega , Obesidade Mórbida/complicações , Complicações Pós-Operatórias/epidemiologia , Reoperação/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
16.
Future Microbiol ; 14: 41-44, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187633

RESUMO

Medical residents (MRs) are healthcare workers (HCWs) who are likely to be exposed to blood-borne pathogens such as hepatitis B virus (HBV). A total of 220 (100%) MRs from Catania University Hospital (Italy) were enrolled for a seroprevalence study in the framework of occupational surveillance in order to evaluate HBV vaccination coverage. For each MR, Hepatitis B surface antigen (HbsAg), Hepatitis B surface antibody (HBsAb), Hepatitis B core antiboy (HbcAb), Hepatitis C antibody (HCV-Ab) and HIV antibody (HIV-Ab) were assessed. No one was found to be positive for: HbsAg, HbcAb, HCV-Ab or HIV-Ab. HBV vaccination coverage was found in 80% of those tested. A total of 45 MRs showed a nonprotective antibody titer; in eight, complete vaccination had never been carried out; in 37, the vaccination had been carried out, but the antibody titer was not protective. This research showed high adherence to HBV vaccination; however, the vaccine coverage of HCWs is still suboptimal. Vaccinations for HCWs should be made mandatory.


Assuntos
Vacinas contra Hepatite B , Hepatite B/epidemiologia , Internato e Residência/estatística & dados numéricos , Cobertura Vacinal/estatística & dados numéricos , Adulto , Feminino , Hepatite B/imunologia , Vacinas contra Hepatite B/administração & dosagem , Hospitais Universitários/estatística & dados numéricos , Humanos , Itália/epidemiologia , Masculino , Estudos Soroepidemiológicos
17.
Future Microbiol ; 14: 27-31, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31187636

RESUMO

Healthcare workers (HCWs) are exposed to biological hazards on a daily basis. The aim of the present study was to evaluate the risks of infection after occupational exposure to blood or body fluids among HCWs operating in the period 2013-2014, in a university hospital of Southern Italy. The frequency of accidents during the 2-year period was always lower than 5%. In 2013, 103 cases occurred; in 2014, the number of injuries had significantly decreased (n = 60). In 2013, an anti-hepatitis B surface antigen protective titer was only found in 70% of cases; in 2014, the subjects with a positive titer rose to 82%. No HCWs showed seroconversion to the main blood-borne pathogens. The implementation of strict prevention measures after the accidents reported in 2013 allowed the significant reduction of the number of injuries in 2014.


Assuntos
Pessoal de Saúde/estatística & dados numéricos , Ferimentos Penetrantes Produzidos por Agulha/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Patógenos Transmitidos pelo Sangue , Hospitais Universitários/estatística & dados numéricos , Humanos , Incidência , Itália/epidemiologia , Ferimentos Penetrantes Produzidos por Agulha/prevenção & controle , Exposição Ocupacional/análise , Exposição Ocupacional/prevenção & controle
18.
BMC Infect Dis ; 19(1): 456, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31117969

RESUMO

BACKGROUND: Rotavirus gastroenteritis is a major public health problem in Nepal. This study was conducted to obtain information associated with Rotavirus gastroenteritis and to perform genotyping of Rotavirus A. METHODS: Hospital based cross sectional study was conducted from January to December 2017 among children less than 5 years of age attending Kanti Children's Hospital and Tribhuvan University Teaching Hospital. Rotavirus A antigen detection was performed by Enzyme Linked Immunosorbent Assay (ELISA) using ProSpecT Rotavirus Microplate Assay. Rotavirus A positive strains were further confirmed by genotyping using Reverse-Transcription Polymerase Chain Reaction (RT-PCR). RESULTS: A total of 1074 stool samples were collected, of them 770 were hospitalized, and 304 were non-hospitalized cases. Rotavirus A infection was found in 28% of children with infection rate higher in hospitalized (34%) than in non-hospitalized (14%) children. Rotavirus A detection was higher in male (31%) than in female (24%), but this was statistically not significant (p > 0.05). Rotavirus A positivity was higher in children of age group 0-23 months, this result was statistically not significant (p > 0.05) with higher frequency found in the months of November, December, January, February and March (p < 0.05). On the basis of molecular analysis of Rotavirus A genotyping, G12P[6] (46.39%) was found to be the predominant followed by G1P[8] (35.05%), G3P[8] (7.21%) and G1P[6] (5.15%) while 4.12% was mixed infection and 1.03% was partially typed (p < 0.05). CONCLUSION: Rotavirus A infection occurred throughout the year, but the infection was significantly higher during the month of March. The higher frequency of rotavirus infection was observed among children of age group 0-23 months; however this was not found to be statistically significant. In this study, G12P[6] is predominant genotype observed. The results of genotyping are essential for the introduction of Rotavirus vaccine in Nepal.


Assuntos
Gastroenterite/epidemiologia , Gastroenterite/virologia , Infecções por Rotavirus/epidemiologia , Rotavirus/genética , Pré-Escolar , Coinfecção/epidemiologia , Estudos Transversais , Diarreia/epidemiologia , Diarreia/virologia , Ensaio de Imunoadsorção Enzimática , Fezes/virologia , Feminino , Genótipo , Hospitais Pediátricos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Nepal/epidemiologia , Rotavirus/patogenicidade , Infecções por Rotavirus/virologia
19.
Work ; 63(1): 57-67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31127745

RESUMO

BACKGROUND: Work-related stress is a significant health and safety concern. OBJECTIVES: To assess the prevalence of burnout and occupational stress among emergency department (ED) professionals and to identify associated factors. METHODS: A cross-sectional study included all ED professionals of a French university hospital. Data were collected using the French versions of the Maslach Burnout Inventory and the Karasek Job Content Questionnaire. RESULTS: Of the 166 respondents (75.8%), 19.3% reported burnout and 27.1% job strain. Factors associated with burnout were work-related dissatisfaction, fear of making mistakes, lack of time to perform tasks, and being younger. Those factors associated with job strain were having at least one sick leave in the past year, being affected by hard work, interpersonal conflicts at workplace, and sleep disorders. CONCLUSIONS: Compared to the literature, our results showed a lower prevalence of burnout among physicians but similar among paramedics. The proportion of professionals with job strain was higher than that of the whole French working population. Organizational factors and the work environment were the primary causes of burnout and job strain, while being younger was the only associated sociodemographic factor. The identification of professionals experiencing difficulty is essential to ensure patient safety, particularly in the high-risk field of emergency medicine.


Assuntos
Esgotamento Profissional/etiologia , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/psicologia , Estresse Psicológico/etiologia , Adulto , Análise de Variância , Esgotamento Profissional/psicologia , Estudos Transversais , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Hospitais Universitários/organização & administração , Hospitais Universitários/estatística & dados numéricos , Humanos , Satisfação no Emprego , Masculino , Pessoa de Meia-Idade , Prevalência , Estresse Psicológico/psicologia , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/normas
20.
Rev Gaucha Enferm ; 40(spe): e20180303, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31038599

RESUMO

OBJECTIVE: To evaluate the occurrences and to characterize the falling incidents of adult patients hospitalized in clinical and surgical units of a university hospital in the southern region of the country, in the period from 2011 to 2014. METHOD: Descriptive, cross-sectional and retrospective study, carried out from December 2016 to December 2017. The sample consisted of 1112 reports, covering all hospitalized patients who were notified with falls occurring in the studied period. Data were analyzed using descriptive and analytical statistics. RESULTS: Female and elderly patients were predominant in the sample, in which 69.4% of the incidents did not present any damage. The occurrence of falls was significantly higher at night. Limitation to walking and being unaccompanied were the most prevalent factors in the patient's conditions before the fall. CONCLUSION: The fall is a multifactorial event that requires periodic evaluation of the risk factors by the team to plan their prevention.


Assuntos
Acidentes por Quedas/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Confusão/epidemiologia , Estudos Transversais , Grupos Diagnósticos Relacionados , Feminino , Humanos , Serviço Hospitalar de Engenharia e Manutenção , Masculino , Pessoa de Meia-Idade , Limitação da Mobilidade , Segurança do Paciente , Estudos Retrospectivos , Fatores de Risco , Gestão de Riscos , Convulsões/epidemiologia , Distribuição por Sexo , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
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